Module 22 Flashcards
(90 cards)
1
Q
What is meant by “high alert” meds?
A
Meds that are likely to cause significant harm when used in error.
2
Q
How do you decide the most effective syringe and needle size?
A
Nurses judgement.
3
Q
What is size of a SubQ syringe?
Needle gauge?
Length?
A
1 - 3 mL
Needle gauge 25/26
3/8 - 5/8”
4
Q
when should you put your gloves on when giving an injection?
A
At bedside, right before you give an injection.
5
Q
What syringe is used for heparin?
A
Tuberculin syringe
6
Q
What size syringes are available for insulin?
A
30, 50, 100 mL
7
Q
What syringes have orange tips?
A
insulin syringes
8
Q
Referring to needle gauges, the smaller the number the _________ the diameter
A
bigger
9
Q
What must you ask before giving a pain med?
A
“What is your level of pain”?
10
Q
What four processes are included when considering pharmacokinetics?
A
Absorption
Distribution
Metabolism
Excretion
11
Q
When and why do you use a filtered needle?
A
Drawing meds out of an ampule in case there is broken glass in it.
12
Q
Why do you introduce air into a vial and how much air?
A
You introduce air in order to reduce the ‘vacuum’. The amount of air is equivalent to the volume meds.
13
Q
What do you label on a vial of reconstituted powdered medication?
A
It must be labeled with date, time, strength and nurse’s initials.
14
Q
What are the three times you change the needles?
A
When you use an ampule, mix medication, and heparin
15
Q
PT Normal range
A
11- 12.5 seconds
16
Q
INR Normal range adult
A
0.8 - 1.1
17
Q
aPTT Normal range
A
30-40 seconds
18
Q
Platelet count Normal range
A
150,000 - 400,000
19
Q
Which check do you have a second nurse verify dose/drug?
A
Second check.
20
Q
How do we check for effective dose of heparin?
A
aPTT (or PTT), Hct, platelet count
21
Q
prefered site of injection for heparin
A
rt/lt lateral lower quadrant
always rotate sites
22
Q
What is the antidote for Heparin?
A
Protamine sulfate.
23
Q
What is the antidote for Coumadin (Warfarin)?
A
Vitamin K
24
Q
Bevel up for which injection?
A
Intradermal
25
Which type of injection do you 'spread' the skin? What angle is the needle inserted?
Intramuscular - 90º
26
What angle do you administer an intradermal injection?
5-15º
27
What angle can you administer a SubQ injection?
either 45º or 90º
28
Explain what you do with regards to skin prior to subq injection after you swab it?
"Bunch up" the skin. Administer injection while skin is bunched up. count to 10 before you withdraw the needle.
29
How is Insulin classified?
By rate of action: rapid, short, intermediate (NPH) and long acting.
30
Which insulin is given IV route?
ONLY Regular insulin (i.e. Humulin R)
31
How is insulin ordered?
It's ordered by specific dose or sliding scale.
32
When should you check your insulin dose with another nurse?
Always!!
33
Why should SubQ sites of injection be rotated?
To prevent the formation of lipohypertrophy or lipoatrophy.
34
What is the order of DRAW for NPH and regular insulin?
Draw regular (fast acting) then draw NPH.
35
What is the onset, peak and duration of heparin?
onset 20-60 minutes, peak 2 hours, duration 8-12 hours.
36
What size syringe should you use to draw up heparin?
TB sized syringe THEN change the needle. 5/8 " needle (subQ)
37
What labs are used to monitor heparin use?
aPTT, Hct, platelet count
38
What injection is not massaged in?
Heparin
39
What part of the body is heparin administered?
Lateral portions of abdominal wall. RLA/LLA
40
how does the reference range for PTT change for a pt. using heparin?
It should be 1.5 - 2.5x the control value.
41
S/S of bleeding due to heparin
bloody gums, bloody nose, unusual bleeding, black tarry stools; hematuria; low Hct or BP
42
What is Lovenox® (enoxaparin)?
Lovenox® is a low molecular weight heparin.
| It comes prepackaged, with an airlock.
43
What is 'tracking'?
Tracking is where the drug comes out through the injection site upon needle withdrawal.
44
What is coumadin (warfarin)?
It's an anticoagulant; IV or oral route
45
What is antidote to coumadin?
Vit K
46
What tests are used to monitor coumadin therapy?
aPTT
PTT 1.3-1.5x control
INR 2.5-3.5
47
What are appropriate sites for SC ?
Outer aspect of upper arms
abdomen below costal margins to iliac crests
anterior aspects of thighs
Why? easily accessible/large enough to allow rotating sites.
48
Define therapeutic effect?
Expected or predictable med action.
48
Name two long acting insulins.
Levemir (insulin detemir)
| Lantus (insulin glargine)
49
Define adverse effect?
Severe response to med
50
Define Idiosyncratic reaction.
over- or under-reaction to a medication
51
Define side effect.
Unintended, secondary effect.
52
Define toxic effect.
Medication accumulates in the blood stream.
53
Define allergic reaction.
Unpredictable response to a medication.
54
What is the meaning of Therapeutic Classification?
It is the medications catagory of usefulness.
| i.e. antipyretic, antibiotic
55
What does pharmacologic classification mean?
It is based upon how the drug works in the body.
56
name several factors that influence medication actions?
```
Age
Renal disease
Liver disease
Route given
Chemical composition
```
57
Methods used to educate a pt. about prescribed meds.
Assess current knowledge of med
Provide generic and brand name
Explain therapeutic benefit
Explain how much and when to take the med
If a dose is missed, have them call physician
Explain duration of therapy
Explain the most common side effects
58
The five common types of medication orders.
```
Standing or routine
single, one time
Now (within 30 minutes)
PRN (when a specific criteria is met)
STAT (immediately)
```
59
What are some factors for not using oral med admin?
```
May:
Irritate stomach
discolor teeth
be destroyed by gastric enzymes
slowest onset of action
```
60
Why do you apply pressure after a heparin injection?
Venipunctures and injection sites require application of pressure to prevent bleeding or hematoma formation.
61
Lab considerations for heparin admin?
Monitor aPTT time and hematocrit prior to and periodically during therapy. When intermittent IV therapy is used, draw aPTT levels 30 min before each dose during initial therapy and then periodically. During continuous administration, monitor aPTT levels every 4 hr during early therapy. For Subcut therapy, draw blood 4–6 hr after injection.
62
How do Fragmin (dalteparin) and Lovenox (enoxaparin) differ from heparin?
They are lower molecular weight and longer lasting (duration). 12/24 hrs vs. 2 hours
63
What labs are used to monitor for Lovenox or Fragmin?
Monitor CBC, platelet count, and stools for occult blood periodically during therapy.
64
range for normal Hct?
varies by age and sex.
Adult male 0.42-0.52 vol fraction
Adult female 0.37-0.47 vol fraction
65
The Z-track method is recommended for IM injections because:
It minimizes local skin irritation by sealing the medication in muscle tissue.
66
The client is a 40-year-old man who weighs 160 lb and is 5 feet 9 inches tall. The order is for 5 ml of a medication to be given as a deep intramuscular (IM) injection. What size of syringe and gauge and length of needle should the nurse use for best practice?
Two 3-ml syringes, 20- to 23-gauge, 1½-inch needle
67
27g - 30g needles
insulin, pediatric IV
68
25g needle
subQ, ID
69
Factors for choosing the right syringe and needle
```
Client age
client height and weight
route to be used (IM, ID, SubQ)
Site to be used (i.e., deltoid, VG)
Viscosity of the med
meds that cause tissue irritation
volume to be administered
```
70
Normal fasting glucose range
70 -110 mg/dL
71
normal NONfasting blood glucose
≥200 mg/dL
72
How many strengths does oxycodone/acetominophen come in?
6 strengths
73
What is type of drug is Ancef?
| What is it's therapeutic use?
cefazolin (generic) - cephalosporin (pharm)
| antibiotic/anti-infective
74
What is metformin? therapeutic use? pharmacological use?
```
type II (oral) hypoglycemic, oral antidiabetic
It decreases hepatic glucose production
```
75
Normal range for WBC's
5000-10,000
76
How do you determine if Humulog R dose is effective?
Test BG levels in 30-60 minutes
77
Normal values for PT
11-12.5 seconds
78
Normal INR value
0.8-1.1
79
Normal aPTT
30-40 seconds, should be 1.5-2.5x more in those w/anticoagulant therapy
80
Normal platelet count
150,000-400,000/mm3
81
S/S HypoGlycemia
Cold, clammy, cranky = need candy
| sweating, impaired vision, weakness, fatigue, increased heart rate, shaking, hunger, headache, irritable
82
S/S hyperglycemia
hot & Dry = sugar high
| Frequent urination, dry skin, nausea, drowsiness, blurred vision, thirst, hunger
83
Landmarks for subcutaneous injections
back of upper arm, lower abs 2" from umbillicus, vastus lateralis, upper ventral or dorsal gluteal areas, scapular areas
84
Landmarks for IM injections
deltoid, vetrogluteal, vastus lateralis
85
Max syringe for IM in adults/children
no more than 3 mL in adults - no more than 1 ml adult deltoid
No more than 1 mL injection for children
86
When do you avoid admin of oral meds?
GI alterations such as N&V
87
Why is if important to consider history of prescribed, herbal and OTC meds?
There could be interactions between new meds and old meds.
88
preferred INR for Coumadin Therapy
2.5-3.5
89
Therapeutic PT ranges for Coumadin
1.3-1.5x > control
